经骶2骶髂螺钉固定的退行性脊柱畸形患者上端固定椎HU值对术后近端交界性后凸的预测价值  

Prediction value of hounsfield units at upper instrumented vertebra for postoperative proximal junctional kyphosis after pelvic fixation with second sacralalar-iliac in patients with degenerative spinal deformity

作　　者：孙幸 李劼 许彦劼 胡宗杉 汤子洋 徐辉 刘臻[1,2] 邱勇[1,2] 朱泽章[1,2] Sun Xing;Li Jie;Xu Yanjie;Hu Zongshan;Tang Ziyang;Xu Hui;Liu Zhen;Qiu Yong;Zhu Zezhang(Division of Spine Surgery,Department of Orthopaedic Surgery,Nanjing Drum Tower Hospital,Clinical College of Nanjing Medical University,Nanjing 210008,China;Division of Spine Surgery,Department of Orthopaedic Surgery,Nanjing Drum Tower Hospital,Medical School of Nanjing University,Nanjing 210008,China)

机构地区：[1]南京医科大学鼓楼临床医学院骨科脊柱外科,南京210008 [2]南京大学医学院附属鼓楼医院骨科脊柱外科,南京210008

出　　处：《中华骨科杂志》2024年第11期730-739,共10页Chinese Journal of Orthopaedics

基　　金：江苏省333高层次人才培养工程((2022)3-1-238);江苏省医学创新中心(CXZX202214)。

摘　　要：目的探讨经骶2骶髂(second sacralalar-iliac,S2AI)螺钉固定的退行性脊柱畸形患者上端固定椎(upper instrumented vertebra,UIV)HU值对术后近端交界性后凸(proximal junctional kyphosis,PJK)的预测价值。方法回顾性分析2015年8月至2021年4月在南京鼓楼医院接受S2AI螺钉固定技术进行骨盆固定的66例退行性脊柱畸形患者的病历资料,男4例、女62例,年龄(61.9±7.3)岁(范围43~78岁),随访时间为(18.4±14.3)个月(范围6~60个月)。术后随访期间PJK发生率为26%(17/66),根据是否发生PJK将患者分为PJK组(17例)及非PJK组(49例)。在术前CT上测量UIV及其上位椎体(UIV+1)以及L3和L4椎体的HU值。术前、术后及末次随访时测量以下影像学参数:胸椎后凸角(thoracic kyphosis,TK)、腰椎前凸角(lumbar lordosis,LL)、骶骨倾斜角(sacral slope,SS)、骨盆倾斜角(pelvic tilt,PT)、骨盆入射角(pelvic incidence,PI)、PI与LL匹配程度(the mismatch between pelvic incidence and lumbar lordosis,PI-LL)、矢状面平衡(sagittal vertical axis,SVA)。比较两组患者的一般资料及HU值,对L3和L4平均HU值与骨密度及骨密度T值行Pearson相关性分析,应用logistics回归分析PJK发生的危险因素。结果两组患者的年龄、性别、随访时间、固定节段数量、骨密度及其T值、L3和L4平均HU值的差异均无统计学意义(P>0.05)。PJK组UIV和UIV+1平均HU值为104.3±32.9,而非PJK组为133.7±29.5,差异有统计学意义(t=3.441,P=0.001)。L3和L4平均HU值与骨密度及骨密度T值呈正相关(r=0.530,P<0.001;r=0.537,P<0.001)。PJK组与非PJK组患者的术后TK、术前LL、LL矫正值,术前PI-LL和PI-LL改变值的差异均有统计学意义。Logistic回归分析显示,UIV和UIV+1平均HU值[OR=0.960,95%CI(0.933,0.987),P=0.004]、LL矫正值[OR=1.049,95%CI(1.007,1.092),P=0.023]是PJK的独立危险因素。通过ROC曲线确定UIV和UIV+1平均HU值临界值为106,LL矫正值的临界值为22.5°。结论应用S2AI螺钉骨盆固定的退行性脊�Objective To investigate the effect of Hounsfield Units(HU)at the upper instrumented vertebra(UIV)on postoperative proximal junctional kyphosis(PJK)after pelvic fixation with second sacral alar-iliac(S2AI)screws in patients with degenerative spinal deformity.Methods A total of 66 patients with degenerative spinal deformity who underwent pelvic fixation with S2AI screws from August 2015 to April 2021 were retrospectively reviewed.The cohort included 4 males and 62 females,aged 61.9±7.3 years(range,43-78 years),with a follow-up period of 18.4±14.3 months(range,6-60 months).The prevalence of PJK was 26%.Patients were divided into two groups based on the occurrence of PJK during postoperative follow-up:the PJK group(17 cases)and the non-PJK group(49 cases).HU measurements were taken at the UIV,the vertebral body cephalad to the UIV(UIV+1),and the L3 and L4 vertebral bodies.The following sagittal radiographic parameters were measured:thoracic kyphosis(TK),lumbar lordosis(LL),sacral slope(SS),pelvic tilt(PT),pelvic incidence(PI),PI minus LL(PI-LL),and sagittal vertical axis(SVA)at preoperative,postoperative,and final follow-up.General information and HU values of the two groups were compared,and Pearson correlation analysis was performed on HU values,bone mineral density(BMD),and T scores.Logistic regression analysis was used to explore the risk factors for PJK.Results The HU values of L3 and L4 were significantly positively correlated with the BMD and T scores respectively(r=0.530,P<0.001;r=0.537,P<0.001).Age,gender,follow-up time,fixation levels,bone mineral density(BMD)and T-score were not significantly different between PJK and non-PJK group.The average HU values of UIV and UIV+1 in PJK group was 104.3±32.9,whlie the average HU values of UIV and UIV+1 in non-PJK group was 133.7±29.5.The difference of HU between the two groups was statistically significant(t=3.441,P=0.001).Logistic regression analysis showed that average HU values of UIV and UIV+1[OR=0.960,95%CI(0.933,0.987),P=0.004]and changes of lumbar lordosi

关 键 词：骨质疏松 骨密度 骨盆 成人脊柱畸形 近端交界性后凸 亨氏单位 

分 类 号：R687.3[医药卫生—骨科学]